McCleary MRSA Prevention

My name is Kathy Day RN. I am a nurse and I am the daughter of a MRSA victim. John P McCleary, my father, died on Janaury 9, 2009 because of Hospital Acquired MRSA pneumonia. He was 83 years old. He fell on Septemeber 26, 2008 and fractured his fibula, the small outside bone of the lower leg. It was a minor fracture that didn’t even require a cast or splint. He also had a urinary tract infection and was treated for that. He had chronic lung problems, but he had never been hospitalized specifically because of that. He was kept in the hospital for 12 days for physical rehabilitation. He worked through his pain from the fracture and he managed to get back on his feet. On October 7, he was discharged home and walked into his home on his own with a walker. On October 9, he couldn’t get up from bed. He had fever and profound weakness. My 82 year old mother had to call the ambulance to return my Dad to the hospital.
In the ER, he was worked up with lab, xray, and urine tests. His admitting diagnosis was Left upper Lobe pneumonia and possible heart problems.
On October 10, the illness stressed Dad so much that he did indeed have a heart attack. His blood pressure dropped dangerously low. He was transferred from his regular bed to an ICU bed for blood transfusions, monitoring, urinary catheterization, and O2 Saturation level monitoring. He was so weak he could barely sip water from a straw. He spent several days in the ICU. When the nurse put his urinary catheter in she told me “he will get an infection”. It was a statement, not a guess. I was so worried that Dad would get bedsores from being wet with  urine that I kind of dismissed that comment. Within 2 days, he had a urinary infection. He had clear urine on this second admission. He not only had an infection, he had a MRSA infection. In the meantime, he had been coughing up large amounts of sputum. I asked if they intended to culture his sputum. The nurse went to check with the doctor and came back to hand me a specimen cup to obtain the sample myself. I did. Two more days passed before the culture came back positive for MRSA pneumonia. Dad had that infection in his lungs on admission. He had passed his infection to his hands from handling his sputum, onto his catheter and up into his bladder.
My family,Dads vistors, all of the staff, and everybody else who came in contact with my father before the MRSA pneumonia diagnosis, were exposed to MRSA. Had the doctor ordered a nasal culture for MRSA screening purposes on admission, my father would have been on the correct precautions from the beginning. Also, because he had fever, and had just been in the hospital, had high risk factors, and showed pneumonia in his lungs, the doctors should have been able to piece together the fact that Dad had MRSA in his lungs, or at least suspected it.  To go back even further than Dad’s infection, if the hopsital had observed the CDC recommendations for follow up of MRSA outbreaks, Dad might not have gotten an infection in the first place. There had been 2 MRSA deaths just one month prior to Dad’s admission and yet the hospital still did not MRSA screening of patients.
My father spent another 20 days in the hospital. He was very weak and debilitated. He got thrush from the Vancomycin. He also had an allergic reaction to it and got an itchy rash all over. His skin began to break down. He was unable to eat. This was the most disturbing part of his disease. His inability to eat was frustrating to him and to his family. He rapidly became malnourished frighteningly thin. He lost most of his hearing, again from the Vancomycin. Ototoxicity is what that is called. He expressed the will and desire to live and get better, but it was just not possible.
Toward the end of his hospital stay, he was given the unfortunate news that he would be transferred to a nursing home. He needed total bed care and my mother and I weren’t able to give that at home. He was never able to stand  or walk again. Attempts were made at the nursing home by a physical therapist to get him back on his feet, but he had syncopal (severe dizziness) episodes…he nearly passed out. He didn’t have a foot under him. So, he spent his last 2 months of life in an isolation room, unable to hear, eat or enjoy anything. He was on constant oxygen and he needed assistance with simple movements. The skin on his sacrum broke down and it began to break down on his heels, toe tips and shoulder blades. All of my family and his other visitors had to wear masks and gloves, so he couldn’t read our lips or see us smile. We couldn’t kiss him. He was frustrated and confused by this sudden decline in his health. He absolutely HATED being in the nursing home.
He had no idea about the fight it took to get him in there instead of 30 to 70 miles away. The day he was to be transferred to the nursing home, which is about 5 minutes away from my parent’s home….we were told there was no bed available. A bed had been promised to us for a full 2 weeks. My mother was self pay, which made it easier to get a bed in the nursing home. When I was told that the bed was no longer available, I called the nursing director of the home. I was told all sorts of nonsense about how they had an “emergency” admission and now there were no male beds left, etc etc. I told them that was totally unfair and I would speak to the director, the medical director, the infection control nurse, the owners and the Governor of the State of Maine if that is what it took to get my father into his hometown nursing home. It took an entire afternoon of staff meetings at that nursing home, but he got a bed. We had to meet 3 demands. One was Dad had to pass the usual Gould assessment test. The second was that Dad would have to wear a mask if he ever left the room there. And third and most unusual, he had to accept Hospice care. He never did accept Hospice. Neither he nor my mother were interested in Hospice and that is a very personal decision. After the fact, I have since learned that it is against the American with Disabilities Act to descriminate against a patient with MRSA, the same as it is for a patient with HIV/AIDS when it comes to nursing home admission.
My father spent 2 very lonely sad months in his isolation room at the nursing home. My mother visited him faithfully two or three times a day. We decorated his room to make it more comfortable, but it wasn’t home and that is what Dad wanted…to go home. It would never happen. Ironically, his mother, my grandmother, died in that same nursing home room 33 years ago.
My mother received a call on January 9 around midnight. Dad had taken a turn for the worse. The doctor also called me. Mike, my husband and I drove 70 miles to the nursing home. My mother and I comforted Dad all night until his respirations slowed and then stopped at 450 am. This was the saddest experience I have ever had in my life. Dad was coherent and alert until almost the very end. The end was peaceful and he knew we were with him and we were ready to let him go. He had wasted away to around 125lbs by the time he passed. He had lost well over 50 lbs.  He barely resembled the big handsome Irishman we had loved all our lives.

 MRSA had killed my father.  The MRSA came from his trusted community hospital.  The treatment for his minor ankle fracture shoule have been simple and short term.

My anger and frustration over this preventable illness has motivated me to do something about it. Doctors told me “it happens and there just isn’t much we can do about it” “Precautions are a nursing thing” (as if it is impossible for a doctor to become contaminated and spread the disease). There was a lot of expressed helplessness and “I don’t know” answers to my questions. I just couldn’t accpept that.
I am from the old school of nursing. Strict sterile technique and precautions were taught and there was NO LEEWAY. Nurses could not pick and choose which parts of precautions they would use. There was a set of rules for certain diseases and that is what we did. Precautions in my fathers hospital were very inconsistant. They ranged from some caregivers not even washing their hands , to others using  full fledged precautions…according to who his nurse was any given day.
Also, the hospital did absolutely NO admission MRSA screening. So, it is likely that he was roomed with somebody else who had MRSA. Three of my father’s 5 roommates during his first hospitalization have died, and all three had respiratory issues. I strongly suspect that he contracted MRSA from an infected roommate. If not, then he contracted it from unwashed contaminated hands or dirty equipment. In any case, his hospital is responsible for is infection and therefore his death.

I contacted the CDC in the State of Maine. To my surprise, MRSA infections are not a reportable disease in Maine. Chicken pox, measles, TB, venereal diseases and avian flu (no cases of this have been contracted within the US) are all reportable diseases. MRSA is not. This allows hospitals to have big or even huge numbers of these infections that complicate patients recoveries or even cause their deaths, and they are not in any way accountable. It is allowed to remain secret. Hospitals even get paid for the extended stays that are caused by these infections.  They cost on an average of $25,000 to $50,000 for each patient who becomes infected.
MRSA infects skin, blood, organs, body cavities, surgical wounds, bone, lungs, central line sites, and joints after replacement. Infections can be superficial to very invasive. Invasive infections cause disability, amputations, long recovery periods, reoccurance of infection and worst of all death, like my father.
For years people have died of ’staph’ infections. MRSA is a staph infection but it is resistant to Methicillin which is a synthetic Pennicillin.  CDC says there were about 100,000 invasive MRSA infections in 2005 and over 18,000 of them died. Some say, because of the lack of accurate reporting that the number is 8 times that high. In any case, there are more deaths from MRSA than from HIV/AIDS. The numbers creep up every year and the numbers are alarmingly high.

I have researched MRSA until my eyes hurt. I decided that Maine needs a MRSA legislation. Illinois and several other States have such legislation and it has helped to decrease their infection numbers. Jeanine Thomas, of the MRSA Survivors Network, has been very helpful to me in my endeavor to write and submit a MRSA prevention proposal to the State legislature in Maine. Adam Goode D-Representative, Bangor, ME, is my chief sponsor. He has worked diligently gaining support for this proposal. I have called and written to numerous Senators and Representatives in the State to rally them and their support. I have met absoluetly NO resistance to my proposal. Maine State Nurses Association is endorsing me and will lobby on my behalf in the Legislature. AARP of Penobscot County has also supported me.
This legislation is past due. Every health care consumer should be concerned about the safety of our hospitals. My proposal includes the major steps to MRSA prevention. Screening, Precautions, Isolation, Reporting, Education, and non descrimination are all the important factors in this proposal.
The citizens of Maine and their representatives will make this bill a law. Please contact your local representatives and Senators to support the McCleary MRSA Prevention bill.